Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome the witnesses to the committee. There is obviously an issue with the impact on the staffing of our health services in terms of consultants but equally in terms of the last point made by the IMO on the broader issue of the impact of cuts on our health service. We hear week in and week out of the pressures on front-line service providers in our emergency departments and of the impact that can have on the acute hospital setting. It is an area we should delve into to determine whether there is a tipping point beyond which negligence becomes a consequence the more we keep paring back on staff and supports for them in our hospitals and health services in general. It is something we should look at as a committee. Health care professional advocacy groups and trade unions have raised that point. Very often, we might take the jaundiced view that it is raised for the purpose of looking for more resources for their members. Equally, one must take into account that they are professionals trying to provide a service to the public and when they say there are risks to patient safety, we should take that on board and investigate. We should note that their comments are not always about self-interest and that they always have patient safety foremost in their minds.

The more I listened to the contribution, the more I realised that the State Claims Agency is paying out, indemnity costs are going up, more people are leaving private medical practice and more patients are ending up in the public health system, which puts more pressure on that system. The common denominator is that it costs the State a great deal of money. While the State is there to pick up the tab, the merry-go-round must stop at some stage. One cannot have a situation where the State is consistently the one that ends up funding everything while also failing to bring forward legislation, the latter being a failing on the part of the Oireachtas. That impacts on the recruitment of consultants, their retention in the private sector and the public health system coming under further pressure.

Somebody said that litigation is not good for patients, but I assure the witnesses that medical negligence is not good for them either. We must try to get the balance right between a litigation-conscious society and our barristers and solicitors moving from other areas of the economy into personal injuries when there is a downturn. While it is accepted internationally that personal injuries increase when there is a downturn in the economy, the question one must ask is whether the cause is cutbacks in our health services leading to a higher incidence of medical negligence or legal professionals moving into personal injuries practice. We might have to do a bit of work on that. The patient is the person who is damaged by medical negligence and he or she has an entitlement to seek redress. We should ensure that there is a seamless, streamlined way for a person to vindicate his or her rights in the most cost-effective way while ensuring that we limit the cost to the State.

What other countries can the witnesses point to that may have a similar type of common law system and a similar type of medical system? What comparative countries could the committee look at to see where things have been done properly and a lower cost of professional indemnity achieved? Where are there high medical and enforcement standards with a legal system that allows people to seek redress? Are we really that far out of kilter with other similar countries in terms of our legal structures and, if so, how far out is that? The capping that was set years ago was breached and then we had court cases where the courts increased the awards by up to 40% in the area of obstetrics. While we tried this before, it has drifted again. We set the caps and it worked for a while, but it seems we have moved back to where we were.

We also have to listen to other groups. Barristers and solicitors should be brought in so that we can discuss the matter with them. In respect of the State Claims Agency and discussions around indemnifying medical professionals, how far down the road has that process gone? Where do witnesses see the benefit in that or is it a matter of transferring the problem from one area of the State to another?

Is there a particular age profile among the consultants who are leaving the country or dropping out of private practice? Are they younger consultants or are consultants in all age cohorts beginning to drift from private practice and to leave the country? I would be very concerned if we were losing the best and our brightest younger people as well.